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Extracorporeal Membrane Oxygenation as a Preoperative Bridge for Infective Endocarditis: A Case Report and Review
Youlian Chen1, Silin Liang1, Shunyao Xu1
1From the Department of Critical Care Medicine, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|July 1, 2026
Summary
Extracorporeal membrane oxygenation (ECMO) can be a viable bridge to surgery for patients with infective endocarditis (IE) and severe cardiopulmonary failure. Surgical intervention significantly improves survival rates in these critically ill patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Infective endocarditis (IE) with refractory cardiopulmonary failure has a high mortality rate.
- Standardized extracorporeal membrane oxygenation (ECMO) protocols for IE are lacking.
- Fulminant IE can lead to acute respiratory distress syndrome and cardiogenic shock.
Purpose of the Study:
- To report a case of successful ECMO bridging for IE with refractory cardiopulmonary failure.
- To contextualize the case with a systematic literature review.
- To propose a hypothesis-generating management algorithm for ECMO in IE.
Main Methods:
- Case report of a 31-year-old male with fulminant IE, severe aortic regurgitation, ARDS, and cardiogenic shock.
- Systematic literature review following PRISMA guidelines (2000-2025).
- Pooled analysis of 22 patient cases (1 case report + 21 literature cases).
Main Results:
- The reported patient survived and was discharged after ECMO, aortic valve replacement, and antimicrobial therapy.
- Overall in-hospital survival rate in the 22-patient cohort was 81.8% (18/22) with ECMO.
- Surgical treatment showed significantly improved survival (94.4%) compared to conservative management (25%).
Conclusions:
- ECMO serves as a feasible bridge-to-surgery strategy for IE patients with refractory cardiopulmonary failure.
- Publication bias in case reports necessitates caution in establishing definitive guidelines.
- Further large-scale prospective studies are required to validate findings and develop clinical guidelines.
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